Angela Cortez IHuman Assignment Help

Angela Cortez iHuman case study is a 17-year-old female who presents with a two-month history of increased fatigue, weight gain, irritability, and tearfulness. She reports being constantly tired and has lost interest in daily activities. Angela has a history of mild acne and is experiencing dissatisfaction with her appearance, though she denies any suicidal ideation.

Upon further assessment, Angela’s symptoms suggest adolescent depression disorder. However, several lab tests are required to rule out other potential causes. Tests such as a Complete Blood Count (CBC), thyroid studies, heterophile antibody tests, and fasting blood sugar tests were all within normal limits, ruling out infections, thyroid disorders, mononucleosis, and diabetes. After excluding these pathological causes, the diagnosis of adolescent depression was confirmed, with a treatment plan consisting of pharmacotherapy and psychotherapy.

NR 602 Week 6 iHUMAN Angela Cortez – Depression Case

Case Summary:

In the NR 602 Week 6 iHUMAN assignment, students are required to assess Angela Cortez, a 17-year-old patient presenting with symptoms of depression. This case study involves evaluating Angela’s mental and physical health, conducting the necessary lab work to rule out other conditions, and formulating a comprehensive care plan based on clinical findings.

Physical Examinations for Angela Cortez

When evaluating Angela Cortez, several key physical examinations and tests are crucial for accurate diagnosis:

1. Physical Examination:
   • BMI Assessment: Angela is mildly obese, which is confirmed during the physical exam.
   • Skin Examination: Mild acne and acanthosis nigricans (darkening of the skin, often associated with insulin resistance) were observed.
   • General Appearance: Tearfulness and an emotional demeanor, indicating distress and dissatisfaction with her body image.
2. Mental Health Evaluation:
   • Patient Health Questionnaire (PHQ-9) Modified for Adolescents (PHQ-A): A self-administered tool to assess Angela’s mood, anxiety, and eating patterns.
   • Psychiatric Evaluation: To assess Angela’s mood, behavior, and mental status for signs of depression.
3. Laboratory Work:
   • Complete Blood Count (CBC): To rule out any infections.
   • Thyroid Studies: To rule out thyroid dysfunction, which can present with similar fatigue symptoms.
   • Heterophile Antibody Test: To exclude mononucleosis as a cause of fatigue.
   • Fasting Blood Sugar & Hemoglobin A1C: To rule out diabetes, especially considering her obesity and family history.
   • Urine Cortisol Test: To exclude Cushing’s syndrome or other endocrine disorders.
   • Pregnancy Test: To rule out pregnancy, given her sexual activity.

Differential Diagnosis

Given Angela’s symptoms of fatigue, irritability, and weight gain, there are several possible differential diagnoses that need to be considered:

1. Adolescent Depression Disorder: The primary diagnosis based on the symptoms of irritability, loss of interest in activities, and emotional distress.
2. Hypothyroidism: Ruled out through thyroid function tests. This condition can also cause fatigue, weight gain, and depression-like symptoms.
3. Mononucleosis: Ruled out through a heterophile antibody test. This viral infection can present with fatigue and lack of energy.
4. Cushing’s Syndrome: A urine cortisol test was performed to rule out this condition, which can cause weight gain and emotional changes.
5. Diabetes Mellitus: Given Angela’s family history and obesity, diabetes was a consideration. However, her fasting blood sugar and hemoglobin A1C were within normal limits.

Problem Statement

Angela Cortez is a 17-year-old female presenting with a two-month history of fatigue, weight gain, irritability, and emotional distress. After ruling out other pathological causes, the diagnosis of adolescent depression disorder was established.

Plan of Care for Angela Cortez

Pharmacotherapy

Selective Serotonin Reuptake Inhibitors (SSRIs): Angela should be started on an SSRI, such as Fluoxetine, which is effective in treating depression in adolescents. SSRIs are preferred due to their low side-effect profile and safety in overdose situations (NIMH, 2018).

Psychotherapy

Cognitive Behavioral Therapy (CBT): CBT should be initiated alongside pharmacotherapy to help Angela address her negative thoughts and behaviors. Psychotherapy is crucial for adolescents suffering from depression, as it can help them regain a sense of control over their emotions.

Safety Contract: Given her emotional state, Angela should be contracted for safety to ensure she does not harm herself or experience suicidal thoughts in the future.

Family Education and Support

Angela’s family should be educated about depression, the side effects of medication, and the importance of adherence to therapy. They should also be made aware of the potential for black-box warnings on antidepressants for increased suicidal ideation in young patients.

Nutritional and Lifestyle Support

Nutritionist Referral: Angela’s obesity should be addressed with the help of a nutritionist who can guide her on healthy eating habits and encourage regular physical activity.

Follow-Up Care

Regular follow-ups with her primary care provider and psychiatrist should be scheduled to assess Angela’s response to the treatment and make necessary adjustments to her medications or therapy.

Angela Cortez iHuman Case Study Essay Example

Introduction

Angela Cortez, a 17-year-old female, presents with symptoms that have been ongoing for the past two months. These symptoms include increased fatigue, recent weight gain, irritability, tearfulness, and loss of interest in daily activities. Angela reports feeling consistently tired and unhappy with her appearance. Notably, she is mildly obese and exhibits mild acne. Despite these concerns, she denies any suicidal ideation. Based on her presentation, Angela’s case suggests adolescent depression; however, further diagnostic workups are necessary to rule out other underlying causes.

Assessment and Diagnostic Workup

To investigate the root cause of Angela’s symptoms, a thorough assessment was conducted. A complete blood count (CBC), thyroid studies, and a heterophile antibody test were ordered to rule out any pathological causes for Angela’s fatigue and energy loss. The results from the CBC and thyroid studies returned within normal limits, ruling out acute infection and thyroid disorders as potential causes. Additionally, the heterophile antibody test came back negative, eliminating mononucleosis as a contributor to her symptoms.

Due to Angela’s irritability and behavioral changes, a urine drug screen was conducted, which showed negative results for drug use. Given her sexual activity with a former boyfriend, a pregnancy test was performed, which also returned negative. Finally, due to her obesity and a family history of diabetes mellitus, a fasting blood sugar and hemoglobin A1C were completed to check for diabetes. These results were also within normal limits.

Having ruled out these potential pathological causes, the healthcare provider could confidently conclude that Angela is likely suffering from adolescent depression.

Treatment Plan

With adolescent depression being the most likely diagnosis, Angela’s treatment plan should consist of both pharmacotherapy and psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological treatment for depression in adolescents due to their minimal side effects and lower risk of overdose. Fluoxetine, an SSRI, has proven particularly effective in treating depression in children and adolescents (National Institute of Mental Health [NIMH], 2018).

In addition to pharmacotherapy, psychotherapy is critical for Angela’s recovery. A combination of cognitive-behavioral therapy (CBT) and medication has been shown to provide the best outcomes in treating adolescent depression. Angela will also be contracted for safety, which means she will sign an agreement stating that she will not harm herself or attempt suicide (NIMH, 2018). This safety contract is essential in managing the mental health of adolescents at risk of self-harm.

Evaluation Tool and Its Importance

The Patient Health Questionnaire (PHQ-9) Modified for Adolescents (PHQ-A) was used to assess Angela’s symptoms. This self-administered tool evaluates mood, anxiety, eating, and substance use disorders in adolescent patients. It is essential in adolescent populations due to their heightened risk for mental health disorders, and it assists in identifying and managing these conditions.

The PHQ-A has been validated by the Journal of Adolescent Health, which demonstrated its diagnostic accuracy and reliability in identifying psychiatric disorders in adolescents. Compared to clinical interviews, the PHQ-A showed similar sensitivity and specificity, making it a highly effective tool in primary care settings for early detection of mental disorders (Gardner, 2014).

Application of the PHQ-A to Angela’s Case

In Angela’s case, the PHQ-A was used to evaluate her current symptoms and behavioral changes. Her responses to the questionnaire revealed a score of 19, indicating a diagnosis of depressive disorder. More than half of her answers fell into the “nearly every day” category, particularly in areas related to feelings, appetite, interests, and concentration over the past two weeks. This assessment confirms the initial suspicion of adolescent depression.

Plan of Care

Based on the results of Angela’s assessment, the following plan of care will be implemented:

1. Psychiatric Referral: Angela will be referred to a psychiatrist for the initiation of both psychotherapy and pharmacotherapy.
2. Medication Management: Fluoxetine, an SSRI, will be prescribed and titrated over several weeks. SSRIs combined with CBT have proven effective in treating adolescent depression.
3. Safety Contract: Angela will sign a no-suicide contract, ensuring that she commits to not harming herself. Additionally, her healthcare provider will assess her suicide risk and inquire about any firearms or harmful items in the home.
4. Family Education: Angela’s family will be educated on depression, including the side effects of SSRIs and the importance of monitoring her mental health. They will also be informed about black box warnings regarding the risk of suicide associated with antidepressant medications.
5. Nutritional Counseling: Given Angela’s obesity, she will be referred to a nutritionist for guidance on healthy eating habits and physical activity.
6. Follow-Up Care: Angela will have regular follow-up visits with her primary care provider to assess her progress and adjust her treatment plan as necessary.

Conclusion

Angela Cortez’s case highlights the importance of a thorough assessment and treatment plan for adolescent depression. By utilizing the PHQ-A and ruling out other pathological causes, her healthcare provider was able to confidently diagnose and develop a comprehensive plan to address her mental health needs. With appropriate pharmacotherapy, psychotherapy, and continuous support, Angela is well-positioned to achieve a positive outcome.

References

Gardner, W. (2014). Screening for mental health problems: Does it work? Journal of Adolescent Health, 55(1), 1-2. https://doi.org/10.1016/j.jadohealth.2014.04.019

National Institute of Mental Health. (2018). Antidepressant medications for children and adolescents: Information for parents and caregivers. Retrieved from https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers

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